HomeSafe Environmental Training
Register Here for Onsite (classroom) Classes
To register for web-based training, go to: HomeSafe Online

Please complete the form below. This registration method holds space for 72 hours. After that, all fees must be paid in full to hold your seat. We accept Business Checks, Money Orders, Credit Cards, & Purchase Orders. 

For Checks/Money Orders:
Complete each section of the form below, then send your Check or M.O. payable to HomeSafe Environmental to:

HomeSafe Environmental Training
RE:  (class title-students name)
24662 Redlands Blvd.
Loma Linda, CA 92354
For Credit Cards:
To pay by credit card (MC. Visa, Discover, AmEx) complete all sections of the form below, then call: 1-800-648-5323 with your CC number.  Or, fax this PDF Registration Form with your credit card info to: (909) 796-2155. 

For Purchase Orders:
To use a Purchase Order, complete all sections of the form below AND type the P.O. # in the "Student Name" text box.  Please call  1-800-648-5323 to confirm arrangements.

(Note: Students will not be admitted unless payment arrangements are complete.)

Each item below is REQUIRED and must be completed.
If "Not Applicable" type: N/A.

Section A. Company Contact (Person responsible for registration)

    1. Name:
    2. Email address: (e.g.: you@aol.com)
    3. Company/Agency Name:
    4. Address:
    5. City:
    6. State:
    7. Zip:
    8. Business phone #: (include AC)
    9. Business fax #: ( include AC; if none put N/A)
Section B. Course Info
    10. What course(s) are you registering for? (Check all that apply)

    Lead Worker (English) (W3)
    Lead Worker (Spanish) (W3Sp)
    Lead Supervisor / Monitor (English) (SSPM)
    Lead Supervisor / Monitor (Spanish) (SSPMSp)
    Lead Inspector / Assessor  (IA)
    Lead General Refresher  (CEg)
    Lead Worker Refresher  (CEW)
    Lead Worker Refresher (Spanish) (CEWSp)
    Mold General Awareness (M101)
    Mold Inspection & Sampling Techniques (M301)
    Mold Abatement/Remediation Techniques (M401)
    Asbestos Worker Refresher  (AWR)
    Asbestos Supervisor Refresher  (ASR)
    HAZWOPER 40-Hr (HZW)
    HAZWOPER 8-hr Refresher (HZR)

    11. What is the first course start date? (i.e. June 6)
    Not sure? Check Schedule.  Hit browser "Back" button to return.

Section C. Student Info
12. How many student's are you registering? (1,2,3 etc.)
    13. List student's name(s): (First, MI, Last)
    If more than one student, list additional names on separate lines.
Section D. Payment
14. How do you intend to pay? (Select one)
Check  Credit Card  P.O.

15. Total amount due:(i.e. $295.00)

Each item above is REQUIRED and must be completed.
If "Not Applicable" type: N/A.

Please send check for correct amount (U.S. Funds) to the address listed above.  Call us at 1-800-648-5323 to pay by Credit Card or FAX your credit card info to us at (909) 796-2155.

Credit Cards

REMEMBER ... your registration is not complete and a seat will not be confirmed until we have received full payment.

    When you are finished, hit the SEND button once. Thanks!

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